Are You Getting Enough Omega-3s? Take a blood test and see…

Omega-3 fatty acids are essential fatty acids in the human diet that are primarily found in oily fish like salmon, sardines, albacore tuna, herring, mackerel, etc. They are also available in fish oil soft gels. The principle omega-3 fatty acids are docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA).  Over the last 25 years, compelling evidence has accumulated from epidemiological studies and large clinical trials demonstrating their beneficial impact on joint, brain, eye, and heart function.  With regard to the cardioprotective effects of omega-3 oils, the strongest evidence to date relates to reducing risk for sudden cardiac death, the primary cause of coronary heart disease (CHD) death in the US today.

The American Heart Association reports that CHD is the number one killer of American men and women, accounting for more than one of every five deaths in the United States, usually as sudden death from cardiac arrest.  Recognizing the cardioprotective effects of omega-3s, the American Heart Association (AHA) recommends that patients with documented CHD should consume about 1,000 mg of omega-3s (specifically, combined DHA+EPA) per day; those without documented CHD should eat a variety of fish, preferably oily, at least twice a week, to provide about 500 mg of EPA+DHA per day.  It is very difficult, however, to reliably estimate omega-3 consumption based upon fatty fish intake because DHA and EPA vary greatly with species, season, maturity, fish’s diet, post-catch processing, and cooking methods.  A high-quality, highly purified fish oil supplement can deliver a more precise amount of omega-3s.  Even then, individual differences in absorption, metabolism, and distribution can lead to variable responses to a given intake.

So how do you know if you are getting enough omega-3s?

Now there is a blood test —the HS-Omega-3 Index™— that can measure your levels of the cardioprotective omega-3 fatty acids, DHA and EPA. Researchers have discovered that one of the best risk indicators for sudden cardiac death is the level of omega-3 fatty acids (EPA and DHA) found in red blood cell membranes. The HS-Omega-3 Index test measures levels of DHA + EPA in the phospholipids of red blood cell membranes and is expressed as a percent of total fatty acids in the membrane.  The result is a simple modifiable marker for the risk of death from coronary heart disease.

The target HS-Omega-3 Index is 8% and above, a level that current research indicates is associated with the lowest risk for death from CHD. On the other hand, an Index of 4% or less (which is common in the US) indicates the highest risk.  Low levels are easily corrected through dietary changes or supplements and can quickly improve test results. Of course, this is just one of a number of risk factors that plays a role in CHD.  Risks associated with other factors such as cholesterol, blood pressure, diabetes, family history of CHD, smoking, or other cardiac conditions are completely independent of and not influenced by omega-3 fatty acids. Any and all modifiable risk factors – including the HS-Omega-3 Index—should be addressed as part of any global risk reduction strategy.

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Differentiating Fish Oils Part 2: What’s in your Fish Oil?

So, now that you understand the different forms that fish oils come in, it would be helpful to know what you’re putting in your mouth when you swallow a fish oil soft gel.  To do this, you have to develop the skill of label-reading.  At first blush this may seem to be a simple task, one not worthy of a blog, but in truth deciphering labels can at times be anything but easy.  I am not suggesting that companies intentionally mislead consumers with marketing and catchy phraseology, but at times they certainly don’t go out of their way to clarify what’s being sold to you.  For instance, what does it mean when a label catches your attention with the bold statement, “1,000 mg of fish oil”? Are you to be comforted knowing that taking just one of these pills meets the American Heart Association’s recommendation for heart patients to take 1,000 mg of the essential omega-3s EPA+DHA daily? More often than not, the answer is NO.  That’s because fish oil does not equal EPA+DHA.  And it’s EPA+DHA that you’re after.  EPA and DHA are the active and beneficial ingredients in fish oil, not the other fats (which include saturated fats as well).  To be sure you are getting what you want and deserve, follow these few steps:

  1. Pay attention to only the “Supplement Facts
  2. Read the “Serving size” – how many soft gels does it take to get one serving? Mark that # down.
  3. Read the “Amount per serving” – how much EPA is there, and how much DHA is there in a single serving? Add the amounts of EPA + DHA per single serving. Write that # down. Ignore “other omega-3s’ or “Total omega-3s”
  4. Let’s say your goal is to get 1,000 mg daily of DHA+EPA. Take “1,000” and divide it by the number you got in step 3. For instance, if the number you arrived at is “500 mg”, then 1,000/500 is 2.  You must take 2 servings to get your 1,000 mg of DHA+EPA daily.
  5. But you must be sure how many soft gels make up a single serving! So, now multiply the answer you got in step 4 by the # you got in step 2. For our current example, this will give you the # of pills needed to get your 1,000 mg of DHA+EPA daily. As the serving size can be 1, 2 or even 3 pills, in the case we’ve constructed you might need to take 2, 4, or even six pills to get what you want! That is why this process is so important.

Remember, the more DHA+EPA there is per gram of fish oil, the more concentrated and pure the oil is.  The more pure the oil, the fewer unnecessary fats you are consuming.  Try to get the purest oils. Extra fat gives you extra and unnecessary calories, something most of us do not need these days.

I hope this has been clear and helpful for you. The next blog, Differentiating Fish Oils Part 3, will discuss the different ways our bodies utilize DHA and EPA.

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First Do No Harm…

One of the most difficult elements of being a physician is caring for someone in pain while having nothing to offer.  We are compelled at least to attempt to provide something palliative, when there is no cure.  But, we must all recognize our goals, and as with any intervention, heed the risks.  We all welcomed Vioxx when it hit the market as the next and best pain reliever.  And for those suffering with the daily draining discomfort and disability of osteoarthritis, Vioxx seemed to be a godsend.  Well, now we know different.  Here it seems the unfortunate risks outweigh the benefits.  Vioxx is clearly out, but where does that leave us?

If you are one of the many who suffer from osteoarthritis this question is surely on your mind.  Osteoarthritis is the most common type of the many forms of arthritis, affecting millions of Americans.  It represents a complex response of our joint tissues to aging and environmental and genetic factors.  It used to be that doctors and patients accepted stiff, painful joints as an inevitable consequence of aging.  And, because osteoarthritis was considered unavoidable, medical intervention focused primarily on relieving pain with nonsteroidal anti-inflammatory medications and steroid injections. That thinking has changed.  It is now understood that the risk and burden of osteoarthritis can be reduced by dietary and other lifestyle changes including all those good things that seem to be generally enhancing for one’s health: exercise, weight control, mind-body techniques that reduce mental and muscular tension, and even a few dietary and nutritional supplements.

Obesity, recently elevated to a major risk factor for coronary heart disease, also causes osteoarthritis.  In fact, though it may appear obvious that weight bearing joints would be damaged by the burden of excess pounds, remarkably not just these joints are more prone to developing arthritis in overweight people.  All joints are affected, implying a systemic effect of obesity as well.  Fortunately this effect is reversible.  And better yet even small amounts of weight loss convey large benefits.  In the Framingham Knee Osteoarthritis Cohort Study, people who lost just 10 pounds or more over ten years cut their risk of osteoarthritis of the knee in half.

Regular exercise, a great weight loss tool, also independently helps stop development or progression of osteoarthritis.  This occurs as a consequence of various physiological changes that follow exercising any joint:  joint fluid production is increased, joint strength is enhanced, pain is lessened and overall joint function has even been shown to be maximized.  Though you might intuitively believe that exercising an already arthritic joint would be bad, the opposite is true.  Exercise improves the damaged joint by stabilizing and strengthening it.  So, if you have not yet been exercising regularly, don’t be intimidated. Just start with whatever you can do easily. Get help if you need it. Just do it!

When it comes to symptom relief there is more good news.  Unbeknownst to many, there is and has been for some time, an alternative to those nonsteroidal anti-inflammatory drugs (NSAIDs).  NSAIDs which can cause stomach pain, kidney damage, and paradoxically, may also inhibit cartilage repair and accelerate cartilage destruction, need not be the mainstay of your treatment. Studies dating back twenty years have been touting the benefits of glucosamine sulfate – a natural product found in the human body.  Glucosamine sulfate exists in the body to build and maintain cartilage, tendons, and other connective tissues while inhibiting the growth of cartilage-destroying enzymes.  Osteoarthritis is the result, in part, of a short supply of glucosamine in our joints, resulting in severe pain and swelling in the joints, and loss of flexibility in the limbs.  The best news is that the benefits of this natural remedy go well beyond symptom relief.  On January 21, 2001 MSNBC reported the conclusions of what the prestigious and quite conservative Lancet medical journal found with respect to use of glucosamine sulfate in treating osteoarthritis.  In no uncertain terms the Lancet article reported, “Previous studies had indicated glucosamine could dull the pain of arthritis, but experts say the latest study shows for the first time that it can improve structure in the joints.”  Studies have shown that oral supplements of glucosamine sulfate are readily absorbed and can lead to stimulation of healthy new cartilage and other protective molecules.  Studies have also shown that this benefit came without any toxicity, contraindications, or other harmful side effects.

Glucosamine should be taken every day.  It is a slow acting supplement that may take up to three months to show its full benefits. Dosage is 1,500 mg per day.  It is best taken with several other components that have been shown to be important in cartilage synthesis and repair.  Chondroitin sulfate also exists naturally in our cartilage and has a synergistic effect when used in combination with glucosamine to treat osteoarthritis and promote overall joint health and resilience.  Enteric coated chondroitin sulfate has been suggested to be most beneficial as it is better absorbed by our bodies.  Several essential vitamins and minerals are important for their role in synthesis and repair of cartilage: Vitamins E and C, Pantethine (Vit B5), Vitamin A and B6, Zinc, and Copper.  Omega-3 fatty acids from fish oils are yet another helpful component:  an excess consumption of omega-6 as compared to omega-3 fats predisposes to inflammation, while supplementing omega-3 fats has been shown to actually diminish inflammation.

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Why Take VitalRemedyMD’s JointFormula?

Given all that we now know about conventional pharmacological treatments of osteoarthritis in contrast with a natural approach using exercise, stress modification and the nutritional supplements glucosamine sulfate and chondroitin sulfate it seems prudent to take the latter approach as a first measure. The natural supplements glucosamine sulfate and chondroitin sulfate have been utilized and studied for over twenty years.  As reported in the finest medical journals they were found to reduce symptoms, improve cartilage and joint health, and reduce joint space narrowing. They are well tolerated and there appear to be no side effects other than mild gastrointestinal upset for some people, which is generally alleviated by taking the supplements with a meal. Vitamins and minerals – B6, E, C, B5, Zinc, and Copper – are included in VitalRemedyMD’s JointFormula as they are known to be essential for maintenance of healthy cartilage and joints.  The addition of the omega-3 fish oils, EPA and DHA, further enhances the potential benefits derived from JointFormula.

Perhaps the best reason to consider JointFormula is that so many of our patients have been pleased with the results, a fact expressed repeatedly in their letters to us:

Dear Doctor, “After my heart surgery you told me to walk, which I did. I was walking three miles in 45 minutes every other day and was feeling good.  However, in the past two years or so, due to my arthritis this became impossible.  The pain in my knees was very severe.  You sent me to my Rheumatologist and he put me on prednisone and methotrexate.  This helped me, but no where near enough.  You advised me to try VitalRemedyMD’s Joint Formula for three months. I did, and in one month it kicked in.  It really works.  I call it “The Miracle Vitamin.”

I have to thank you for prescribing the vitamin JointFormula.  For the first time in three years I have not had fluid drained from my osteoarthritic knees.

Dear Doctor, “I have to thank you for prescribing the vitamin JointFormula.  For the first time in three years I have not had fluid drained from my osteoarthritic knees.  Previously I had my knees drained every two to three months, plus cortisone shots, to relieve severe pain.  Since I have taken JointFormula, I have not had any fluid in my knees and I no longer take Darvocet for pain.  You know that I am a pessimist from the word go, and I reluctantly took the pills, but I am so glad you convinced me to do so.  Again, thank you.”

Dear Doctor, “For years I suffered with lower back pain in the area of my tailbone.  I saw several physicians, had CT-scans and X-rays, but no one could find the cause.  The last physician I saw said it might be some kind of arthritis.  When I told my husband about this, he said that he heard that your JointFormula worked great on arthritic joints.  Being a skeptic, I said that I would try it, but would only take two a day instead of the recommended four.  After about a month with little change I decided to stop taking them.  My husband convinced me to continue them at the recommended four a day regimen.  After two weeks I began to notice a difference and after a month, the pain was almost completely gone.  It has now been six months since I started them and the pain is gone.  As a bonus, the moderate pain that I was experiencing in my elbow is also gone!  Thanks so much for such a great product.”

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